I am both a US and a Canadian citizen. I am in the unusual position of having practiced in Canada before the development of universal government-funded health care known as Medicare, followed by practice in the US without universal health care, followed by practice back in Canada when Medicare had been established. Having experienced the worst of US medical care, I decided to never again practice in the US. I fear today for Canadian health care as it drifts toward a US-style private model. I developed and ran a three centre health care network in Rochester New York 1970-75, where I also practiced. I had good contracts with Blue Cross for the employed of Kodak, Xerox and American Optical, and I had a good reimbursement rate for those who were destitute on Medicaid. In the middle we tried to care for the marginal poor or sometimes employed. It can’t be done. What I faced as an administrator in trying to be fair to those who cannot pay eventually put the system in jeopardy. This loomed large in my decision to return to Canada, where I ran a similar system in Montreal from 1975-1993. There I no longer worried about providing cost effective care. Our Canadian health care system has not had a major overhaul since its inception in the 1970s, but we need to work on fixing those problems through comprehensive health care reform, without destroying a system that most Canadians feel is an expression of the highest values in our society. Those who see an increase in private care as the main way to fix the system seem unable to separate their own financial benefit from the needs of the nation. While I looked in the US for a warm place where my wife Bonnie, who is handicapped, could be independent, in the end I was so distressed with the US private-for-profit system that permeated everything from how poor people were cared for to the educational system that seemed blind to what was happening around them, that I felt that I had no choice but to return to Canada. It is useful to think about how Bonnie was flown without charge from Quebec to Ontario on a specialized intensive care jet to receive landmark surgery unavailable in Quebec, how the costs of her many months in hospital were the price of room TV. Or when I required back treatments then unavailable in Canada, Quebec paid for me to receive care in Minneapolis. Unlike what many in the US believe, there are no restrictions in Canada on choice of physician, assuming availability. In fact, our system is largely entrepreneurial and uncontrolled, unless the doctor is on salary, which is still rare. Some would say that ours is not a health care system at all but a system of paying doctors and hospitals for providing services according to a schedule of payments. And we are unique among comparable Western societies because we do not fund essential drug costs for the patient. I am astonished, though I ought not be, that many Americans, who are one disease short of being destitute, believe that single payer health care is bad for them. Part of the US population’s refusal to embrace the obvious is achieved by scaring them with terms like “socialism” and the spectre of a Canadian system where people cannot choose their own doctor and they will not receive the care that they need. Canadians of course can see their own doctor, and as many times as they need, without cost to them, just by showing their Medicare card. Lies about the Canadian health care system are willfully propagated by US private insurance interests, and ignorant legislators in the pocket of lobbyists are believed by a naïve and unsophisticated public. While there are undeniable problems in the Canadian health care system, compared to the US we are in much better shape, and we can fix our problems, within the existing system-- if we put our minds and pockets to it.
Working in both the US and Canada as a doctor #DAresists #Medicare4all
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